Labral Tears, Extra-articular Injuries, and Hip Arthroscopy in the Athlete

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Labrum anatomy

The hip joint is a ball and socket joint enveloped in dense capsular tissue. The Y-shaped triradiate cartilage acetabulum covers 170° of the femoral head [3]. The acetabular labrum is a fibrocartilaginous structure that outlines the acetabular socket. Labral attachment occurs at the periphery of the labrum to the capsule, and is anchored anteriorly and posteriorly at the acetabular transverse ligament. The posterior labrum has a sulcus that can be mistaken for pathology (Fig. 1). Its free

Labral tears

The etiology for labral tears can be from traumatic and degenerative causes, structural abnormalities from femoroacetabular impingement (cam and pincer type lesions) [9], developmental abnormalities from dysplasia, old slip epiphysis and Perthes disease [9], and hip instability [10].

Traumatic tears in athletes can occur from an isolated event, or more commonly from repetitive trauma [2]. Traumatic hip dislocations are also susceptible to labral tears. Acetabular fractures that occurred from

Classification of labral tears

Labral tears in athletes have been demonstrated to occur mainly anterior-superior, but can also occur in conjunction with posterior tears [11]. Labral tears are characterized by their location and by their morphology. Labral tears have been classified morphologically as: radial flap, radial fibrillated, and longitudinal peripheral and unstable tears (Fig. 8) [14]. Labral tears have also been classified based on histologic analysis of cadaveric specimens [15]. Type 1 labral tear is a detached

Associated intra-articular injuries

The most common associated lesions with labral tears in athletes are chondral injuries [2]. These injuries are usually adjacent to the labral pathology [2], [11], [12]. Chondral changes include chondromalacia, thinning of the cartilage, delamination of the cartilage, chondral flap tears (Fig. 10), and full-thickness chondral injury with exposed bone (Fig. 11). Lateral impaction injuries seen with football injuries have been reported [16].

Ligamentum teres in conjunction with labral tears has

Examination findings

A detailed history of the onset of symptoms—traumatic event or insidious onset of symptoms—and the level of athletic participation before and after injury should be elicited from the athlete. An assessment of possible referred hip pain from low back pain or abdominal or gynecologic disorders should also be considered. Risk factors for avascular necrosis (AVN) and stress fractures should be obtained in the history as well. Mechanical symptoms of the hip related to a single traumatic event or

Arthroscopic management

Hip arthroscopy can be performed in either the supine approach, as popularized by Byrd [22], or the lateral approach [23], popularized by Glick and McCarthy. This procedure is generally performed on a fracture table to apply gentle hip distraction and allow for fluoroscopy. Philippon [2] has developed a modified supine position (see Fig. 16) in which the table is tilted 10° to keep the femoral neck parallel to the floor, the hip is slightly flexed 10° and internally rotated, and the lower

Return to sport

Return to competition after hip arthroscopy in a motivated athlete with the aid of athletic trainers and physical therapists can be successful. The author's series of professional athletes who had labral tears from seven different sports demonstrated successful return to preinjury athletic activity after hip arthroscopy [11]. The earliest return to sport was seen with the golfers (average 6 weeks), followed by hockey players and skaters. Baseball and soccer players averaged twelve weeks.

Summary

Labral tears in athletes can lead to disabling hip pain and affect their athletic performance. Isolated athletic injury or repetitive traumatic activity can lead to labral tears; however, underlying structural (femoroacetabular impingement) and developmental abnormalities predisposing athletes to labral pathology must also be addressed. Recent studies [11], [12] have demonstrated lesions associated with acetabular labral tears, and that labral tears uncommonly occur as isolated injuries. Return

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References (32)

  • J.W.T. Byrd et al.

    Hip arthroscopy in athletes

    Clin Sports Med

    (2001)
  • M.J. Philippon

    Arthoscopy of the hip in the management of the athlete

  • R.C. Wasielewski

    The hip

  • Y.T. Kim et al.

    The nerve endings of the acetabular labrum

    Clin Orthop

    (1995)
  • M.J. Philippon

    The role of arthroscopic thermal capsulorrhaphy in the hip

    Clin Sports Med

    (2001)
  • Bharam S., Draovitch P., Fu F.H., et al. Return to competition in pro athletes with traumatic labral tears of the hip....
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      Similarly, Casartelli et al.,24 in a previous systematic review involving 18 case series (977 patients), reported that 87% of athletes returned to sport and 82% returned to the same sport level as before the occurrence of the symptoms. Philippon et al.25 analysed return to sport in a cohort of professional hockey athletes: goaltenders showed a greater risk of labral damages, especially if FAI was present.26,27 The authors reported excellent outcomes, with 100% of return to practice sport within two-years after surgical treatment.25

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